Endoscopy is defined as a direct visualization of body cavities by the use of an instrument called an ENDOSCOPE (a small slender telescope with a built-in light source for illumination and a video camera at the back end of the endoscope connected to a TV monitor). When the body cavity of the abdomen is entered during the operation, it is called LAPAROSCOPY, on the chest it's THORACOSCOPY and the lower abdomen or pelvic region it's PELVISCOPY.
The early beginning of Endoscopic Surgery took placed in Europe and pioneered by Gynecologists where they performed tubal ligations, removal of ovarian tumors or cysts, lysis of adhesions and as a diagnostic procedure. Some of these surgeons were brave enough to remove the appendixes through 1/2 inch abdominal incisions.
It was the successful and safe removal of the appendix that led the aggressive and innovative general surgeons to explore the vast potential of the new surgical technology. Thus, the removal of the gall bladder or Laparoscopic Cholecystectomy was first performed in Europe in 1987 and only attracted minor curiosity. General surgeons were slow in accepting this new video assisted surgery but the procedure crossed the Atlantic in the early 1988 and thereafter several U.S. Surgical Centers began using this new operative technology with unerring success. The Laparoscopic Cholecystectomy has now become a standard Operative procedure in removing a diseased gall bladder.
The laparoscopic approach to the gall bladder and other organs has distinct advantages over the standard open technique in that, for many procedures visualization is very much improved as the endoscope can be placed directly over the surgical field several times magnified. Other advantages include reduced hospitalization, health care costs, a more rapid and less painful convalescence with faster return to employment and finally an improved cosmetic postoperative incisional wound scars results.
The introduction of state-of-the art instruments and equipment has made possible the diversified laparoscopic surgical procedures now being used in many hospitals throughout the United States and some countries around the world. The surgeon with his laparoscope inserted into the abdominal cavity through a 1/2 inch incision and a few more additional similar incisions for the delicate slender instruments like dissectors, tissue grasping forceps, suture-ligatures and laser probe, manipulates these tools outside the body cavity to remove the diseased gall bladder by watching a video screen monitor. Surgeon's hands are no longer in direct contact with body tissues when performing these maneuvers in the new laparoscopic surgery and all intricate movements executed intracorporeally and extracorporeally are assisted by the indirect viewing provided by the Endoscope Video-T.V. Monitor system.
The new initiate in this high-tech endoscopic surgical procedures is met with difficulties in the visual orientation and eye-hand coordination. To acquire operative skill required to gain competence in this video assisted surgical procedures and maintain the proficiency of the surgeon, he must continuously as often as possible perform these intricate maneuvers on live patients and must practice on inanimate objects using an apparatus like the present invention.
The earlier model made and widely used training device were built in Germany and one such device is called Semm Pelvi-Trainer. This simulator has a transparent panel on top with several openings where instruments and viewing scope are inserted and manipulated. It is provided with a method of holding organs which are suspended from the top panel using bead chains and clips. The exercise procedures are performed on living tissues like placenta or even muscle. Though these devices have prominent features, they also have significant drawbacks. This particular model was primarily constructed for training Gynecologists so that simulation of endoscopic operative techniques are geared and limited to the pelvic organs, thus it is appropriately named `Pelvi-Trainer`.
Although this simulator functions satisfactorily in most cases, it tends to suffer from several problems which limits its usefulness. One such drawback is that, it encourages the use of Pelviscope (Endoscope I, please refer to Key Words). Endoscopes are expensive and are not readily available to many surgeons much less to the initiates.
Yet another drawback of the Pelvi-Trainer is that, when the surgeon uses the Pelviscope, he actually carries out the simulated instrumentation and practice procedures under direct monocular vision. This type of visualization as applied in endoscopic surgery has been replaced by Endoscope-Video-Monitor System which operates under indirect binocular vision, a system that is being used in actual live endoscopic operations and in some other training devices.
Still another drawback of this simulator is that, it has only one plastic panel with multiple openings that are positioned primarily for practice procedure on the pelvic cavity. It has no provision for practice simulation in the other body cavities like the chest, upper abdomen and the region of the kidneys.
Additional drawback of the Pelvi-Trainer is that, in the practice of simulation, the trainee can only use human tissue like placenta or animal parts. These materials are not readily available and their procurement might be difficult.
Another simulator that is recently brought out to the public is the Mckeown surgical training apparatus. This is an apparatus that has all its sides of black plexiglass making the inside cavity pitch-dark. This device apparently functions substantially identical in some aspects to the Semm Pelvi-Trainer One drawback that is very evident is that, the trainee has to use the apparatus with the aid of a scope (Endoscope I) which provides a magnified direct monocular vision similar to the Semm Pelvi-Trainer.
Yet another drawback of this apparatus is that, it has provision only for practice simulation on materials like animal parts or even human tissue which are suspended from the top plexiglass panel by chain beads and clips, a method exactly similar to the Semm Pelvi-Trainer.
The top lid plexiglass of the McKeown apparatus has multiple puncture positions that are appropriately used for simulation practice exercise on limited organ location, i.e., the placement and location of the apertures on the top lid is not suitable for practice simulation of endoscopic surgery on the chest or in the region of the kidneys and this is also a drawback of the device.
Still another drawback of this training apparatus is that, the trainee must always use an endoscope to perform practice simulation. The endoscope is an expensive item and are not readily available to most trainees, therefore the use of such apparatus is limited to hospital setting where the endoscope might be accessible to the trainee.
Another drawback of this device is that, the mounting of the organ object being practiced on is by clamps on bead chains suspended from the top plexiglass panel which makes the object a moving target and would need a steady hands to perform simulated delicate sewing technique and a near perfect result might be difficult to achieve.
It is clear and evident that the present invention has proven to have advantages over the other simulators and the versatility of its function is a welcome asset in achieving improved skill on eye-hand coordination. The fact that the present invention has shown distinct features that none of the other simulators possess makes it more desirable for the surgeon to practice simulation techniques on this recent cutting edge simulator. First, one advantage of the present invention over the others is the use of the Two Mirror Concept, a system of indirect binocular way of viewing objects and simulation of activities inside the cavity of the simulator. This is the same viewing method used in real life operative conditions with the aid of the Endoscopic-Video-Monitor System.
Second, the individual user can perform practice procedure in simulating visual and instrument manipulation on the present invention under indirect binocular vision applying either system. If for some reason the Endoscopic-Video-Monitor System is not available, the trainee can still practice simulation that mimics true to life operating situations using the Two Mirror Concept System, a feat unmatched by the other simulators.
Third, with the interchangeable clear and transparent plastic panels that have strategically positioned apertures, the surgeon can simulate practice surgical procedures mimicking real life operating conditions on the different body cavities like the chest, upper abdomen, pelvic and the region of the kidneys by using the specific panel for each individual operative technique on the chosen cavity. These practice maneuvers when translated into the actual live operation, the individual user will recall where to place the punctures on the body wall.
Fourth, additional advantage of the present invention over the other simulators is the use of life size object-simulations which are made of foam rubber mounted and anchored on pads and platforms of the same material in a unique modular arrangement. This is an important feature not provided by the other simulators and one that appeals to the individual user because it's easier to change wornout object-simulations during practice procedure.
Fifth, the present invention is constructed with all lateral sides completely open allowing easy access to the inside cavity for placement and removal of object-simulations used in the exercise procedure and the open sides permits easy cleaning after the simulation experience. Some of the simulators are partially enclosed and provided by side panel with access window which may require more time to clean the inside cavity after using objects like, human placenta or animal tissue.